Pediatric Nephrotic Syndrome

A report describes a case of a 2-year-old boy weighing 15 kg, who reported a high-grade continuous type fever along with chills and rigors. He also had cough (wet cough more in amount) whitish color sputum which was not foul-smelling. His face was swollen which initiated around the peril-orbital (which was more during the morning) and gradually progressed to the face which decreased by evening. Reduced urine output was also reported. 

Examination revealed a pitting type of edema over lower limbs and swelling over the face which indicated the diagnosis of nephrotic syndrome.

Laboratory findings indicated proteinuria, with no signs of hematuria. Blood tests showed a reduced C3 level and hypoalbuminaemia suggesting nephrotic syndrome (NS). The urine creatinine level was found to be 620 mg/L (within range) while APTT was prolonged- 47.7 Sec. Serologic testing for active infections: anti-streptolysin-O titer came out to be positive. The lipid levels were significantly increased. The urine protein/creatinine ratio came out to be high (7.3). Mantoux test was negative.

After establishing the diagnosis of nephrotic syndrome, optimal supportive treatment was given with Enalapril p.o., Prednisolone p.o., intravenous albumin, furosemide, low salt intake, high caloric and protein diet along with Ceftriaxone and Ascoril-LS. Continuous monitoring of urine output and blood pressure was done.

Peripheral edema controlled with albumin and diuresis with furosemide. Reduction in peri-orbital edema and leg swelling reduced, increase in serum protein levels and gradual reduction in lipid levels (without any medication) were seen.

Prince S, Naresh K, Tulasi R. Case Report on Paediatric Nephrotic Syndrome. EJIFCC. 2020;31(2):164-168. Published 2020 Jun 2.